How computer games can treat ADHD and PTSD by rewiring your brain and allowing safe role-play

We talk to the director of the Games For Change festival in New York, Susanna Pollack, about games that alter brain circuitry, relieve stress, increase empathy and attention span, and allow people to develop coping skills

Playing computer games can be good for your mental health. That’s one of the messages of the Games for Change Festival, an annual event that focuses on how games – and now virtual reality and augmented reality – can be designed and used for positive outcomes in health, education and civics. The 15th edition of the festival, run by the non-profit Games for Change organisation, took place in New York from June 28 to 30, attracting more than 1,100 attendees to hear 150 speakers.

In a wide-ranging interview ahead of the event, Games for Change president and festival director Susanna Pollack told the Post that games can be designed to benefit mental health in two main ways. The act of gameplay can affect the neural circuitry of the brain in positive ways, and games can also be used to relieve stress by allowing users to role-play traumatic situations in a safe environment.

“Game mechanics are designed to drive engagement – people have a special attraction to games due to their ability to immerse the player in an environment and a story,” she says. “Researchers have found that games can change cognitive development – that games can improve cognitive neurological transmissions.”

Tetris is about spatial awareness, and the spatial patterns in the game disrupt the process and stop the traumatic experiences you are holding in your short-term memory moving over to your long-term memory. It’s fascinating

Susanne Pollack, director and president of Games For Change

Game environments can also be designed to develop empathy and coping skills in young people who are experiencing situations like bullying. “In a game, users are able to role-play such situations without fear.”

A neuroscience and health programme at the festival explored how gameplay affects brain function, and a Brain Jam pairs neuroscientists with game developers to foster collaboration between the two disciplines.

“Certain types of game experiences cause changes to occur in the brain,” Pollack says. “For instance, Dr Adam Gazzaley, a neuroscientist who works at University of California San Francisco, is studying how specific forms of gameplay can help to treat people with attention deficit hyperactivity disorder (ADHD).

He has been running trials for two years, and has a game at the US Food and Drug Administration for approval. Gazzaley and his team have been looking at how patterns of gameplay that focus on maintaining attention and eliminating distraction can change the way the brain is wired in the long term. That is potentially a permanent way of rewiring the brain to stop someone suffering from ADHD. The change results from the actions players take, and the repetitive behaviour involved.”

The popular game Tetris, in which players try to organise rows of descending shapes, has also been put to good use, notes Pollack.

“There has been some really interesting work done on Tetris, which focuses on how it can interrupt the process of short-term memory turning into long-term memory,” she says. The game could be used by sufferers of post-traumatic stress disorder (PTSD) to stop the memory of the traumatic event becoming permanent.

“Tetris is about spatial awareness, and the spatial patterns in the game disrupt the process and stop the traumatic experiences you are holding in your short-term memory moving over to your long-term memory. It’s fascinating.”

Environmental games, by contrast, let players place themselves in an environment that allows them to release stress, or experience a sense of support.

Designers of such games often aim to inspire a “sense of awe” in the players, which “can release certain hormones that are also released when you are surrounded by nature,” Pollack says, “even though you are in a digital environment. Some have this feeling for the first time as part of a digital experience. There have been experiments with this in virtual reality as well.”

Elude, a Singapore-MIT GameLab prototype available at the Games for Change website, is an example of such a game.

Role playing has long been a part of commercial computer games, and such techniques have been used in therapeutic games, too.

“Role playing games can provide a safe space for people to recreate a traumatic event, or learn how to manage a stressful situation like bullying. You can have a simulated experience that is pre-scripted. Artificial intelligence can add an extra layer by allowing users to develop social skills through a reconstructed experience. They can then transfer these skills to real life,” Pollack says.

Games get their power due to their interactive nature. The player’s inherent desire to master the game provides motivation, and players learn actively, rather than passively by watching or listening. “The fact that you can change the outcome of the game makes it engaging,” she adds. “You have a different relationship with the characters in a game than you do with characters in a film or a book. What’s more, you can learn for yourself as you go – you have a different relationship with the content.”

Pollack says that the games – many of which are still in development – are not designed to replace one-on-one sessions with a therapist, although some of them may have the capacity to do just that. Instead, they are often used to augment traditional treatment. One advantage is that the pressure is off with a computer game – there is no embarrassment and no fear of humiliation, shame, or failure.

“There are many people who are uncomfortable in a face-to-face environment. It’s not my place to say the games are a replacement for human contact, but they are certainly additive – they are another way to explore and work through these issues,” she says.

Commercial games – for instance, shoot-’em ups – are designed to hook players and keep them going back to the gameplay. That effect can be used advantageously in therapeutic games to ensure patients continue their treatment. “Game mechanics are used to make people keep coming back in commercial games – essentially, a commercial game has to be fun. A game doesn’t have to be lighthearted or silly, but it has to be engaging,” she says.

“There has to be a relationship between the player and the game that makes them want to come back for more. The skill of game design is that you want the gameplay to be hard enough to be interesting, but you don’t want it to be so hard that it becomes frustrating. But it can’t be too easy, either.” Similar concepts apply to therapeutic games, she says.

The big question is whether such games can bring about behavioural change in players. Pollack says that Re-Mission, a game developed by Hopelab, illustrates that they can.

“Hopelab has been conducting studies into how the game can change behaviour in young cancer patients, and how it can help them stick to their medical treatment over a long period of time. Re-Mission does seem to achieve this goal,” she says.

“Ongoing exposure to this game, in which patients shoot bad blood cells with nanobots, gives the players a sense of empowerment. It’s structured in a way that players come to feel that they can take control of their recovery. This triggers connections in the brain that make them more likely to continue with their medical treatment.”